Presented By: Michelle Ashley, Lisa Le, Anthea Mourselas, Gayle Young, and Rachel Zimmerman

Where there is a void of factual information, stigma and prejudice often rush in to fill the space (Taylor, 2010, para. 1).

What is Addiction?
Is it environmental? Is it physiological? Is it psychological? Is it societal?

"You do not just wake up one day and become an addict. -Jan

(Jan, personal communication, February 19, 2014.)

Opiates
Opiates originate from the dry milk of the opium poppy.

Analgesic that depresses the central nervous system by blocking pain receptors.
The most common opiates are heroin,

morphine, OxyContin, Vicodin, and Fentanyl.

(Institute for Substance Abuse Treatment Evaluation, n.d. ; National Institute on Drug Abuse, 2006)

Retrieved from www.drugaddiction.org

U.S.A. Opiate Addiction

Currently, approximately 1 million people in the United States are addicted to heroin (Office of National Drug Control Policy, 2000), and more than 3 million people over the age of 12 have used heroin at least once [National Survey on Drug Use and Health (NSDUH), 2004]. What's more, an estimated 1.4 million people are dependent on or abusing other opiate drugs, including prescription painkillers [NSDUH (Ibid)].
(National Institute on Drug Abuse, 2006)

Demographics

(Williams & Latkin, 2007)

2011-2012 Drug Use Data

(National Institute on Drug Abuse, 2014)

Dependence Among Substances

(National Institute on Drug Abuse, 2014)

Customary Practices
Ingestion of opiate will depend on the drug Heroin:
Liquefied & Injected Smoked Sniffed/snorted
Retrieved from www.lapalomatreatment.com

Prescription opiates:
Pill form Crushed, sniffed/ snorted Liquefied; patch

Retrieved from prescription-drug.addictionblog.org

The Effects
People of all ages suffer the harmful consequences

of drug abuse and addiction. Babies exposed to legal and illegal drugs in the womb may be born premature and underweight. Adolescents who abuse drugs often act out, do poorly academically, and drop out of school. Adults who abuse drugs often have problems thinking clearly, remembering, and paying attention. Parents' drug abuse often means chaotic, stressfilled homes and child abuse and neglect.

Stereotypes & Truth

Drug addicts are often seen as morally flawed or lacking in willpower.

Addiction is a disease that affects both brain and behavior.

Biological and environmental factors have been identified. Scientist are looking for the genetic variations that contribute to the development and progression of the disease.

Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities.

Retrieved from: http://www.drugaddictiontreatment.ca/addiction-treatment-options/heroinaddiction/

Description of A
A is a 28-year-old female who is a former drug

addict. Her addiction started when she was 15 y.o due to the pressure of school and the desire to attend to a good college. Her addiction was to Methamphetamines ( aka Tweek). During her first year of college at UCLA she realized she was an addict. She had two relapses before successfully quitting at 25-years-old. because she was diagnosed with bi-polar disorder and the medication created a balance for her.

She described that she was successful in quitting

Description of Jan
Jan is a 64-year-old recovering heroin addict. She first tried heroin at the age of 13. At 21-years-old she discontinued using drugs due to

having a child. Verbally abused by mother, sexually abused by grandfather.

Repressed memories, discovered later in therapy.

She is now employed as a Methadone counselor and has

been clean for over 40 years.

One morning, I woke up and I told myself I cannot live like this or I will die. So I went to my first NA meeting.
(Jan, personal communication, February 19, 2014)

Description of Lucy Fields

Lucy is a 30-year-old female recovering from a Vicodin addiction. Her addiction started in her early adolescence. She comes from an educated upper middle class family. She is currently getting treatment including buprenorphine. During treatment reveals she had a traumatic event as a child involving the death of her younger sister.

Lucy Fields Cont.

Lucy on her relapse at her sisters wedding during her recovery period: It didnt really trigger a craving. Not a craving for drugs. It triggered hopelessness. My life doesnt matter. Its already too bad to fix. I cant resolve it. It will never get better. Thats when the idea of using drugs enters my brain. No its not about the drugs. Its just that Im overwhelmed. Its a fight I cant win. Im not sure what I want: to be happy, to not use drugs, to have a healthy productive life? I get melodramatic. I start thinking I deserve to suffer for some reason and then I start to believe it (Stein, p. 204, 2009).

Addictive Personalities?
Dr. Michael Stein author from The Addict (2009) discusses: Research shows that addiction comes from an interaction between susceptibility and precipitant, between genetic makeup and environment.
Strong family history or traumatic event

However, some believe its a result of a personal

failing or moral weakness.

Opiates do not affect everyone in the same way:

Tom felt anesthetized, Julia physically energized and dangerously alivebut most people feel nothing more than pain relief, a little nausea, a little dizzy; this last group never becomes addicted (p.58).

Infant
Homeless Person
Professional Athlete

Roles
Physician

Parent
College Student

Why Do Drugs?
In general, people begin taking drugs for a variety of reasons: To feel good To feel better To do better To find out what its like and to fit in

Values of Use
Pain
Tolerance

Coping
Past traumatic event Current stress levels

Pressure for Success

Professional/Academic Personal Factors

OT-Related Treatments
Based on Transtheoretical Model
Brief Interventions
Investigate potential problem

Cognitive-Behavioral Theory (CBT):

Develop successful coping behaviors to reduce relapse

Motivational Strategies:

Motivational interviewing Decision balance exercises Motivational Enhancement Therapy (MET) FRAMES: Feedback Responsibility Advice Menu Empathy and Self-efficacy

12 Step Programs
Help to promote and sustain recovery
(Stoffel & Moyers, 2004)

OT-Related Treatments (cont.)

Evidence-based practice
Brief Interventions
Helpful in moving clients from precontemplation to

contemplation

CBT & Motivational Strategies

Effective in facilitating clients decision to seek

treatment Best used when client ready for change Most effective when used in a combination with 12 step programs

12 Step Programs
Most successful when client has a history of using

external supports

(Stoffel & Moyers, 2004)

Drug Treatments

Buprenorphine Partial m agonist 36-48 hour half-life Less abuse potential Ceiling effect limits overdose risk Mild-moderate dependence Mild withdrawal symptoms Tablet risk of injection Moderately expensive

Methadone
Full m agonist
24-36 hour half-life More abuse potential No protective overdose factors

More effective for severe

dependence
Moderate-severe withdrawal Oral liquid-less risk of injection Inexpensive

(Whelan & Remski, 2012)

Methadone Study
De Maeyer et al. (2011) found 5 themes related

to reasons for remaining on methadone:

Having social relationships 2. Holding an occupation 3. Feeling good about one's self 4. Being independent 5. Having a meaningful life
1.

3 negative themes also emerged:

Stigmatisation 2. Discrimination 3. Dependence
1.

Marginalized Medical Treatment Options

Dr. Michael Stein author of The Addict (2009) discusses: His colleagues prefer not to work with addicts because they are complicated and distressing. Society tends to view drug addicts as just problematic and helpless but not as someone with a mental illness or a disease.
Addiction is the only is disease that is illegal to have (p.241).

Methadone programs are housed in rundown

neighborhoods. Counselors are usually former addicts with little training, fewer than half are licensed.

Famous Faces of Addiction

Phillip Seymour Hoffman

46-years-old: heroin overdose
Hoffman struggled with addiction. After two decades of

sobriety, starting with prescription pills and escalating to snorting heroin.

(Retrieved from http://news.yahoo.com)

(Retrieved from www.people .com)

Angelina Jolie
She has previously discussed her past experimentation with drugs (including Heroin) as a suicidal, depressed 20something living in New York.
(Retrieved from http://www.examiner.com)

administrators, teaching staff, BRAVE program members

(Retrieved from pinkhope.org.au)

Cory Monteith
31-years-old: heroin & alcohol overdose
Cory didn't look or act like an addict. He was happy,

successful, and seemingly had it all." -Jane Lynch

(Retrieved from www.eonline.com)

(Retrieved from www.businessinsider.com)

Matthew Perry
Speaking at the Clinton Global Initiative, Perry said of his decision to enter rehab: "I realized that if I stepped outside of myself and lived for others I'd be happy."
(Retrieved from http://www.digitalspy.com)

(Retrieved from www.zimbio.com)

Florence Nightingale
It was discovered

after her death that the most famous nurse who ever lived was a notorious opiate user.administrators, teaching staff, BRAVE program members
administrators, teaching staff, BRAVE program members

(Retrieved from http://www.medhelp.org)

(Retrieved from www.mydaily.com)

Heath Ledger
Accidental overdose at 28-years-old of prescription medications including painkillers (opiates), antianxiety drugs and sleeping pills.
Rumored that he got deeper and deeper into drugs as his fears of losing his daughter increased.
(Retrieved from www.dailymail.co.uk )

(Retrieved from www.biography.com)

Amy Winehouse
Died at 27 after a 36-hour whisky, cocaine and heroin bender, according to a tabloid report.
In various interviews, she admitted to having such problems with selfharm, depression, and eating disorders.
(Retrieved from http://en.wikipedia.org/wik i/Amy_Winehouse)
(Retrieved from www.riffraf.net)

Questions?

References
CBS News. (2013).Formal NFL quarterback Ray Lucas hopes story of painkiller addiction will lead others to get help. [Website]. Retrieved from http://www.cbsnews.com/news/former-nfl-quarterback-ray-lucas-hopes-story-of-painkiller-addiction-will-lead-others-to-get-help/ Cleveland.com (2012). Babies born to opiate-addicted moms go through withdrawal. [Website]. Retrieved from http://www.cleveland.com/healthfit/index.ssf/2012/09/opioid-addicted_women_are_givi.html De Maeyer, J., Vanderplasschen, W., Camfield, L., Vanheule, S., Sabbe, B., & Broekaert, E. (2011). A good quality of life under the influence of methadone: A qualitative study among opiate-dependent individuals. International Journal of Nursing Studies, 48(10), 1244-1257. doi: 10.1016/j.ijnurstu.2011.03.009 Institute for Substance Abuse Treatment Evaluation. (n.d.). Institute for substance abuse treatment evaluation : Tennessee outcomes for alcohol and drug services: Opiate. Retrieved from http://www.isate.memphis.edu/opiate.html Kane-Willis, K., Schmitz, S., Bazan, M., Narloch, W., & Wallace, C. (n.d.) Understanding suburban heroin use. Retrieved from http://heroin.robertcrown.org/files/Understanding_suburban_heroin_use.pdf Merlo, L. J., & Gold, M. S. (2008). Prescription opioid abuse and dependence among physicians: hypotheses and treatment. Harvard review of psychiatry,16(3), 181-194. doi:10.1080/10673220802160316

National Institute on Drug Abuse. (2014). Drug facts: Nationwide trends. [Website]. Retrieved from http://www.drugabuse.gov/publications/drugfacts/nationwide-trends
National Institute on Drug Abuse. (2006, August). Buprenorphine: Treatment for opiate addiction right in the doctor's office [PDF document]. Retrieved from http://www.drugabuse.gov/sites/default/files/bupren.pdf Rutgers Today (2012). Rising opiate and heroin abuse among young adults a public health academic. [Website]. Retrieved from http://news.rutgers.edu/special-content/fall-2012/rising-opiate-and-he-20121016#.UwzODvldWSp Stein, M. (2009). The addict: One patient, one doctor, one year. New York, NY: Harper Perennial. Stoffel, V. C., & Moyers, P. A. (2004). An evidence-based and occupational perspective of interventions for persons with substance use-disorders. American Journal of Occupational Therapy, 58(5), 570-586. doi:10.5014/ajot.58.5.570 Taylor, D. (2010, August 24). Not just junkies: the stigmatizing of drug addicts . The Guardian. Retrieved from http://www.theguardian.com/commentisfree/2010/aug/24/stop-stigmatising-drug-addicts Whelan, P. J., & Remski, K. (2012). Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of Neuroscience in Rural Practice, 3(1), 45-50. doi: 10.4103/0976-3147.91934 Williams, C. T., & Latkin, C. A. (2007). Neighborhood socioeconomic status, personal network attributes, and use of heroin and cocaine. American Journal of Preventive Medicine, 32(6 Suppl), S203-S210. doi: 10.1016/j.amepre.2007.02.006

The New Faces of Addiction

http://www.youtube.com/watch?v=cskq_zGV

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